Arteries & circulation
Heart attack
What is a heart attack?
If you’ve had a heart attack and you’re reading this, you’re lucky.
In the US, approximately 800,000 people each year will have a heart attack and 96,000 (12%) will die as a result. Death rates have fallen by more than 50% in the past 20 years, largely because of improved treatment options, but having a heart attack is still a very risky business.
Globally, cardiovascular diseases were the leading cause of death in 2019, and a total of 15 million people died as a result of heart attacks and strokes alone.
We all know the term “heart attack”, but it’s easy to confuse it with things like cardiac arrest and heart failure.
In cardiac arrest, the heart stops beating, often suddenly and usually because of an electrical malfunction. A heart attack certainly may cause your heart to arrest, but there are many other more likely causes.
Heart failure is a condition where your heart is unable to pump as efficiently as it should. Your body is starved of oxygen and fluid often builds up in your lungs, feet, and legs. If left untreated, heart failure can eventually be fatal. Take a look at our Heart failure section if you would like to learn more.
A heart attack – or a myocardial infarction, as it is formally known – happens when one of your coronary arteries is blocked by a blood clot or a piece of atherosclerotic plaque.
Your coronary arteries supply blood to your heart muscle and, when oxygenated blood can’t get through, the part of your heart muscle normally supplied by the blocked coronary artery begins to die.
So what does a heart attack feel like?
The symptoms of a heart attack typically include chest pain that spreads to your shoulder, arm, neck, or jaw, and also difficulty breathing, a cold sweat, and extreme tiredness. However, some people, especially some women, have symptoms that are not considered typical.
Atypical symptoms include indigestion, nausea, and back pain. Occasionally heart attack sufferers report feeling no chest pain at all.
It is critically important that you immediately seek emergency medical care if you think you’re having a heart attack. The faster the blockage in your coronary artery can be cleared, the less likely it is that your heart will be permanently damaged.
Heart attack: Atherosclerosis, blood clot, and damaged heart muscle
Throughout the world, men are more likely to have heart attacks than women. A US study, published in 2021, found that the heart attack death rate among men was almost 3 times higher than the rate among women in the same age group.
Historically, men have been more likely to have unhealthy lifestyle habits, like drinking to excess and smoking, and this may play a part.
Family history contributes significantly to your risk of developing heart disease and having a heart attack but most of your risk is related to your own lifestyle choices.
Most heart attacks happen because atherosclerotic plaque has blocked one of your coronary arteries and, as we saw in the Atherosclerosis section, atherosclerosis is overwhelmingly a disease caused by an unhealthy lifestyle.
Smoking, being overweight, eating a fatty, salty, sugary diet rich in processed foods, and not exercising, will catch up with you as you age, and a lifestyle that seemed like fun in your 20s and 30s can be problematic by the time you reach your late 50s and 60s.
We understand that we keep beating on this same drum, but an unhealthy lifestyle can kill you, and it’s worth noting that having a heart attack is only one of many ways that can be accomplished.
Recovering from a heart attack can take months, depending on how much damage your heart has sustained. However, rehabilitation programs can help get you back to normal and provide support for any changes you might want to make to your diet and routine of daily activities.
What causes a heart attack?
Ninety-five percent of the time, heart attacks are the result of coronary artery disease – a coronary artery blockage caused by atherosclerosis.
Your coronary arteries are big blood vessels that keep your heart muscle supplied with oxygenated blood and, when one is blocked, the part of the heart muscle that is deprived of oxygen as a result begins to die.
Occasionally, heart attacks can be caused by coronary artery spasm, take a look at variant angina in our Angina section, or a blood clot or other blockage that isn’t related to atherosclerosis. However, in the vast majority of cases, the villain is atherosclerosis.
And the vast majority of the time, atherosclerosis is caused by an unhealthy lifestyle, so while the immediate cause of a heart attack is a blocked coronary artery the ultimate cause is poor diet, smoking, lack of exercise, and the many other health problems, like type 2 diabetes, that go along with these.
Causes of a heart attack include:
- Atherosclerosis (95% of the time)
- Coronary artery spasm
- A blood clot or other blockage (an embolism) not related to atherosclerosis
- An electrolyte imbalance, which might be caused by severe dehydration, eating disorders, kidney disease, or other problems
- Family history and genetic heart defects
What are the symptoms of a heart attack?
The symptoms of a heart attack are similar to those of angina. Take a look at our Angina section to learn more.
It can be very hard to tell whether you’re having a heart attack, which is a serious medical emergency, or your first episode of stable angina, which is not, but if you experience the symptoms listed below, you should immediately seek emergency medical help.
- Chest pain or discomfort that may spread to your arms, neck, jaw, or shoulders
- Abdominal discomfort that feels like severe heartburn or indigestion
- Shortness of breath or trouble breathing
- Sweating, nausea, dizziness, or anxiety
- Tiredness
If you experience these symptoms you should immediately seek medical assistance.
It’s very important to remember that not all heart attack sufferers experience the same symptoms, and women, especially, are likely to have symptoms that don’t immediately seem alarming.
Many studies have shown that, while women have a lower overall risk of heart attack than men, across all age ranges, their risk of dying if they are having a heart attack is often higher, and this may be partly related to delays in seeking and receiving care.
How is a heart attack treated?
The immediate and most urgent goal of treatment for a heart attack is to restore blood flow to the heart as quickly as possible. The longer it is deprived of blood, and therefore oxygen, the greater the risk of permanent damage to the affected section of the heart muscle, and the greater the risk of death.
Restoring blood flow can be done with medication or surgery, or both.
Medications include:
- Blood-thinning medications to prevent additional clots: Aspirin and heparin are good examples
- Clot-dissolving drugs (usually only given within the first 12 hours after symptoms began)
- Nitroglycerin to open up blood vessels (this is also used to treat angina)
- Antiarrhythmic medications to help control the heart’s rhythm and rate
Surgical procedures include:
- Angioplasty: A tube with a deflated balloon attached is threaded into the blocked artery and the balloon is then inflated to widen the area of the blockage
- Stenting: During angioplasty, a stent, which is a wire-mesh tube, might be inserted to permanently keep the artery open
- Coronary artery bypass: A healthy blood vessel from another part of your body is transplanted to your heart and used to bypass the clogged coronary artery
Long term, your doctor may prescribe additional medications to help prevent you from having another heart attack. These may include:
- Medications used to treat hypertension that will reduce the stress on your heart
- Drugs called statins, which are used to lower cholesterol levels and will help prevent further build-up of plaque in your coronary arteries
What are the aims of treatment?
The immediate aim of treatment for a heart attack is to reopen your blocked coronary artery or arteries and restore blood flow to your heart. This is urgent: The longer your heart muscle is starved of oxygen, the more likely it is to be permanently damaged.
The long-term aim of treatment is to prevent you from having another heart attack.